Provider Demographics
NPI:1316616600
Name:VOGT, ALISHIA BROOKE (LMSW)
Entity type:Individual
Prefix:
First Name:ALISHIA
Middle Name:BROOKE
Last Name:VOGT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4552 RIVERMONT TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-2000
Mailing Address - Country:US
Mailing Address - Phone:314-952-2955
Mailing Address - Fax:
Practice Address - Street 1:12166 OLD BIG BEND RD STE 204
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6836
Practice Address - Country:US
Practice Address - Phone:314-952-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019045328OtherLICENSE